Examples: Our first patient is a 73-year-old man who presented for Mohs surgery to treat squamous cell carcinoma of the right temple. The final defect size measured 1.2 x 1.3 cm and extended to the fascia. The defect was repaired with a layered linear closure using 5-0 monocryl interrupted deep sutures, followed by 5-0 monocryl intradermal sutures to approximate the epidermal edge. The final wound length measured 3.1 cm. Photos were taken immediately after surgery (Figure 1) and at 4-week follow-up (Figure 2). Suture removal was unnecessary as only dissolvable sutures were used.
The second patient is a 33-year-old woman who was found to have a malignant melanoma in situ on her left shin (Figure 3). She had an excision performed with 5 mm margins, and the resultant 1.6 x 1.4 cm defect extended to fascia. Since she is a surgical resident and needs to be on her feet for long days in the operating room, the defect was repaired with a layered linear closure using 3-0 PDS interrupted deep sutures, followed by a 4-0 prolene running intradermal suture that was left in place for 2 months before suture removal (Figure 4).
These cases demonstrate the superior cosmetic outcome offered by buried intradermal suture. Possibly due to how wound closures are traditionally taught in dermatology, simple inter
rupted or continuous sutures are overwhelmingly favored by dermatologic surgeons in superficial repair, especially on cosmetically sensitive areas such as the face and ears.1
However, scars on the trunk and extremities closed with simple interrupted suturing often result in suboptimal aesthetic outcomes. While dermatologists can now offer energy-based devices and neuromodulators to improve cosmesis, our approach helps optimize scar appearance so that patients can have the best possible surgical outcome without necessitating further interventions. By using a superficial repair method that minimizes epidermal trauma without compromising structural integrity, dermatologic surgeons can maximize patient satisfaction while providing excellent medical care.
All authors have no potential perceived conflicts of interest and/ or financial relationships that may pertain to the subject matter in the manuscript.
- Adams B, Levy R, Rademaker AE, Goldberg LH, Alam M. Frequency of use of suturing and repair techniques preferred by dermatologic surgeons. Dermatol Surg. 2006;32(5):682-689.
- Akeroyd J, Kitada HH, Plauntz L, Lear W. Nurses’ experience removing superficial nonabsorbable sutures from the skin: wound overgrowth of sutures complicates the procedure. J Dermatol Nurses Assoc. 2017;9(1):16-20.
- Regula CG, Yag-Howard C. Suture Products and Techniques: What to Use, Where, and Why. Dermatol Surg. 2015;41 Suppl 10:S187-200.
Elizabeth K. Hale MD Ekhale@hotmail.com